COALINGA STATE HOSPITAL. Effective Date: August 31, 2006

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1 COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION Emergency Procedures POLICY NUMBER: 715 Effective Date: August 31, 2006 SUBJECT: EMERGENCY CARE OF HEMORRHAGE 1. PURPOSE: The management of hemorrhage can be a very serious, life-threatening, and panic-producing situation. Measures to stop the blood loss, immediate volume replacement, and the activation of the Emergency Medical Response (EMR) System are the primary focus. 2. POLICY: Nursing staff shall immediately evaluate the Individual to determine the medical emergency status (LIFE THREATENING call 7119; NON LIFE THREATENING call 7111) and take appropriate action. Nursing personnel, having direct or the potential for contact with exposure to blood, body fluids, or other potentially infectious material of Individuals are expected to practice STANDARD PRECAUTIONS according to guidelines established by the CSH Infection Control Program. Personal protective equipment and engineering controls shall be used during care of the Individual with hemorrhage and as needed. Refer to Standard Precautions. 3. COMPETENCY/TRAINING: All Level of Care nursing staff are required to take First Aid training at time of hire and every three years thereafter as part of Mandated Training. 4. DEFINITION: Hemorrhage is a loss of a large or copious amount of blood either externally or internally in a short period of time. 5. TYPES OF BLEEDING: Arterial bleeding - Are bright red and gushes forth in waves; related to heart rhythm; if vessel is very deep, flow will be steady. -1-

2 Venous bleeding - is dark red and flows smoothly. Capillary bleeding - is oozing of dark red blood; self-sealing controls this bleeding. 6. GENERAL INFORMATION: A pressure dressing is a temporary treatment for the control of excessive bleeding. The bleeding is usually sudden and not anticipated. It may be a lifethreatening occurrence related to accidental trauma, stabbing, suicide attempt, or other injury. The best way to stop external hemorrhage is direct pressure over the area of the wound. Most bleeding will stop within a few minutes when firm, direct pressure is applied for 5 to 15 minutes. If there is bleeding from a foot, hand, leg or arm, use gravity to help slow the flow of blood. Elevate the limb so that it is higher off the ground than the victim s heart. If bleeding cannot be stopped by using direct pressure or by elevating the injured area, you may have to slow the supply of the blood using pressure points. Major arteries may be compressed against the bone to stop the blood flow. This can be accomplished by feeling for the victim s pulse at the pressure point and pressing until no pulse is felt. However, because pressing these areas can completely stop the supply of blood, do so only in extreme emergencies. Alternate between using pressure points and direct pressure every couple of minutes until help arrives. An adult weighing 70 kg has a total volume of 5 liters of circulating blood. All nursing actions must be rapidly and effectively executed when excessive blood loss occurs. Once pressure has been applied, it must continue until definitive actions can be executed. INTERNAL BLEEDING: is to be suspected when the following warning signs are exhibited: coughing up or vomiting up blood or coffee ground material, passing blood in urine or stool, or passing black tarlike bowel movements. All require medical attention. Have the Individual lie on his or her back and elevate his feet. Have Individual breathe deeply. Keep Individual NPO and activate Medical Emergency. 7. EPECTED OUTCOME: 1. Bleeding is controlled. 2. Fluid loss is minimal. 3. Individual s blood pressure and pulse remain within normal range. -2-

3 4. Circulation to distal parts is adequate. 8. ASSESSMENT: Bleeding may be evident or concealed. Clinical manifestations of blood loss may include: -Skin that feels cool or moist or looks pale or bluish -Rapid, thready, weak pulse -Rapid shallow breathing -Decreased blood pressure -Apprehension -Excessive thirst -Vomiting or coughing up blood -Tender, swollen, bruised, or hard areas of the body, such as the abdomen -Becoming confused, faint, drowsy, or unconscious 9. INTERVENTION: NURSING ACTION A. Phase i: immediate action first nursing staff on the scene : Quickly assess the Individual's airway, breathing and circulation. Activate Emergency Medical Response System. Locate external bleeding site. Apply direct pressure immediately. B. Direct additional staff to call for physician and the RN. Have someone bring the emergency equipment to the scene. C. Phase ii: applying pressure dressing - second nursing staff on the scene : Quickly observe location of bleeding. Put on gloves, and gown if appropriate. Apply firm, manual pressure dressing over the wound or artery involved. KEY POINTS A. Rapidly cover bleeding area with many thicknesses of compresses. Use sterile cause pads or improvise if necessary by using a sanitary napkin(s), clean towels or handkerchief. B. Dial "7119" for hospital medical assistance and "7119" for paramedic assistance. (Refer to NPPM #700 Medical Emergency ). C. Personal protective equipment packets are available in the bottom drawer of the Emergency Cart and in the Red/White Emergency bag. -3-

4 D. Quickly assess Individual s pulse, blood pressure, skin color, anxiety/restlessness, changes in level of consciousness. D. Findings of tachycardia, hypotension, diaphoresis, restlessness, and diminished urinary output indicate impending hypovolemic shock. E. Elevate the injured part to control venous/capillary bleeding if a fracture is not suspected. Immobilize an injured extremity to control blood loss. E. Raise the injured area above the level of the heart. F. If bleeding is not controlled, apply pressure on the artery between the wound and heart. (pressure point). F. A pressure point is a spot on the body where you can squeeze the nearby artery against the bone underneath. This can slow or stop the flow of blood to the wound. G. An IV of Normal Saline or D5W TKO (to keep vein open) may be started by RN s who are I.V. proficient prior to a physician s order in Life Threatening emergencies. A physician s order for starting the IV must be obtained ASAP. G. The IV needle should be the largest bore available. Rapid initiation of an IV is essential to help the body cope with the blood loss. H. Keep Individual warm. H. Reassure and comfort the victim. I. Monitor vital signs every 15 minutes or more frequent if Individual's condition deteriorates. J. Apply a tourniquet, ONLY as a last resort. If tourniquet is applied, do not loosen or remove unless ordered by physician. Mark time applied. I. Be alert for signs and symptoms of shock. (Refer to NPPM #707 Shock ). J. The decision to apply a tourniquet is to risk sacrifice of a limb to save a life. 10. EVALUATION AND DOCUMENTATION: Status of Individual s bleeding control, time bleeding was discovered, estimated blood loss, nursing interventions (including effectiveness of -4-

5 applied pressure dressing), apical and distal pulses, blood pressure, sensorium level, signs of restlessness. Document all events of the emergency. Include date, time, history of emergency, location of bleeding, describe type of blood vessel and approximate blood loss, arrival time of medical help, and time bleeding was control/stopped, disposition of Individual and condition of transfer. Provide information at the Change of Shift report. FUNCTIONS FIRST MEDIC ZOLL 1600 LIFE PAK 7 Monitoring Mode Semi-Automatic Adhesive Pads Used For Manual Synchronized Cardioversion External Pacing Variable Leads 3 Lead Monitoring Change in ECG size High and Low Rate Alarms Memory Card Memory Module and Tape Recorder 100 Joule Energy Setting in Manual Mode Additional Energy Settings in Manual Mode -5-

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